ProgressiveDem: Bushite Medicare and Its Contractor Fail To Detect Fraud In Home Medical Equipment
Bushite Medicare and Its Contractor Fail To Detect Fraud In Home Medical Equipment
Bush's mission to privatize and politicize federal departments and agencies is ongoing and one of the reasons that fraud and waste are rampant during this criminal administration.
The Department of Health and Human Services which is busy trying to stop the availability of contraception to women, has a terrible track record as far as detecting and halting fraud against Medicare purchase of home medical equipment.
Why? Because checking of claims has been outsourced to a private contractor, which, of course, costs more than keeping it in house and using Civil Service employees to check claims.
But that is the Bushite MO: privatize for more corporate profits by feeding at the government trough.
As the NYTimes reports: "The rate of improper payments, including fraud, in Medicare's purchases of wheelchairs and other home medical equipment is significantly higher than the government has estimated, according to a federal audit released yesterday.
"The report by Inspector General Daniel R. Levinson at the Department of Health and Human Services found an "error rate" of almost 29 percent in a sample of claims paid in 2006 under Medicare's multibillion-dollar durable medical equipment program. The Centers for Medicare and Medicaid Services had estimated a rate of 7.5 percent, or about $700 million in improper payments.
"Investigators reviewed a sample of 363 claims to determine whether the Medicare contractor that routinely checks such claims had found all of the improper payments. Such payments include not only fraudulent claims, but also those without sufficient documentation and those for goods deemed not medically necessary. The new review found 20 payment errors that the contractor identified and 73 that it had not.
" 'We attributed these review discrepancies to the . . . contractor's reliance on clinical inference rather than additional medical records available from health care providers, CMS's inconsistent policies regarding proof-of-delivery documentation, physicians' lack of understanding of documentation requirements and CMS's lack of procedures for obtaining information on high risk DME [durable medical equipment] items from beneficiaries," Levinson wrote in a cover letter for the report.
"Hundreds of millions of dollars are at stake in reducing payment errors. The durable medical equipment program, which costs more than $8 billion annually and pays for power wheelchairs, hospital beds, oxygen supplies and other equipment for home use, has long been considered vulnerable to waste, fraud and abuse.
"A July report by the Government Accountability Office, for instance, found that Medicare has paid as much as $92 million since 2000 to suppliers who billed the government for equipment purportedly prescribed by doctors who were dead."
The article does not identify the Medicare contracting company that is supposed to check these claims.
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